288: Consecutive intra-umbilical vein injection of misoprostol and intravenous sulprostone in the management of retained placenta: a retrospective cohort study

Abstract

and intravenous sulprostone in the management of retained placenta: a retrospective cohort study Frouke Notten, Liesbeth Scheepers Maastricht University Medical Center, GROWSchool for Oncology and Developmental Biology,Department of Obstetrics and Gynaecology, Maastricht, Netherlands, Maastricht University Medical Centre, GROWSchool for Oncology and Developmental Biology,Department of Obstetrics and Gynaecology, Maastricht, Netherlands OBJECTIVE: The treatment of retained placenta (RP) is manual removal of the placenta (MRP). A randomized controlled trial concluded that intravenous administration of sulprostone reduces the need for MRP. Intra umbilical vein injection of uterotonics is also used, but oxytocin seems ineffective. We compare the use of intraumbilical misoprostol followed if necessary by intravenous sulprostone, with expectative management followed by MRP after 60 minutes. In both groups blood loss 500 cc or hemodynamic instability was reason for immediate MRP. Our primary outcomes are the need for MRP and the amount of blood loss. STUDY DESIGN: We compared cohort A (1-1-2007 to 31-09-2008) managed by an expectant protocol, with cohort B (1-4-2009 to 31-122010) managed by a medical intervention protocol. We collected data from women with a vaginal delivery after 24 weeks of gestation. Women who didnt expell the placenta after 20 minutes were included. Baselinecharacteristics were not different. The chi square ( 2) and sample T test were used to analyse data. Results were considered significant if p 0,05. RESULTS: In cohort A 1936 women gave birth, of 275 women the placenta was not expelled after 20 minutes and 57 (20.7%) women needed MRP. In cohort B 2149 women gave birth, of 219 women the placenta was not expelled after 20 minutes and 35 (16.1%) women needed MRP. There was no significant difference in the number of MRPs or blood loss. Per protocol analyses did not show differences in results. Subgroupanalysis showed a trend (p 0.099) towards less MRPs after 34 weeks in the medical intervention cohort. CONCLUSION: We conclude that the use of intra-umbilical misoprostol and intravenous sulprostone consecutively, did not reduce the number of MRPs as well as the total amount of blood loss. The trend towards less MRPs in the medical intervention group is probably caused by more active management towards the expulsion of the placenta in the second time period. Considering the risks and side effects of the use of these drugs, we reject routine use in the management of RP. 289 Cost-effectiveness of induction of labor at term with a Foley catheter compared to prostaglandin E2 gel (based on the PROBAAT trial; registration NTR 1646) Gert-Jan van Baaren, Marta Jozwiak, Katrien Oude Rengerink, Marjan Benthem, Marja G.K. Dijksterhuis, Marloes E. van Huizen, Paulien C.M. van der Salm, Nico W.E. Schuitemaker, Dimitri N.M. Papatsonis, Denise A.M. Perquin, Martina Porath, Joris A.M. van der Post, Robert J.P. Rijnders, Hubertina C.J. Scheepers, Marc Spaanderman, Marielle G. van Pampus, Jan Willem de Leeuw, Ben W.J. Mol, Kitty W.M. Bloemenkamp Academic Medical Center, Department of Obstetrics and Gynecology, Amsterdam, Netherlands, Groene Hart Hospital, Department of Obstetrics and Gynecology, Gouda, Netherlands, Academic Medical Center, Department of Obstetrics and Gynaecology, Amsterdam, Netherlands, University Medical Center Groningen, Department of Obstetrics and Gynecology, Groningen, Netherlands, Ikazia Hospital, Department of Obstetrics and Gynecology, Rotterdam, Netherlands, Haga Hospital, Department of Obstetrics and Gynecology, The Hague, Netherlands, Meander Medical Center, Department of Obstetrics and Gynecology, Amersfoort, Netherlands, Diakonessen Hospital, Department of Obstetrics and Gynecology, Utrecht, Netherland Antilles, Amphia Hospital, Department of Obstetrics and Gynecology, Breda, Netherlands, Medical Centre Leeuwarden, Department of Obstetrics and Gynecology, Leeuwarden, Netherlands, Maxima Medical Center, Department of Obstetrics and Gynecology, Veldhoven, Netherlands, Jeroen Bosch Hospital, Department of Obstetrics and Gynecology, Den Bosch, Netherlands, Maastricht University Medical Centre, Department of Obstetrics and Gynecology, Maastricht, Netherlands, UMC St. Radboud, Department of Obstetrics and Gynecology, Nijmegen, Netherlands, University Medical Centre Groningen, Department of Obstetrics and Gynecology, Groningen, Netherlands, Ikazia Hospital, Department of Obstetrics and Gynecology, Rotterdam, Netherlands, Leiden University Medical Centre, Department of Obstetrics and Gynecology, Leiden, Netherlands OBJECTIVE: To assess the economic consequences of term induction of labor using a Foley catheter compared to prostaglandin E2 gel. STUDY DESIGN: We performed a cost-effectiveness analysis alongside a multicenter randomized clinical trial comparing Foley catheters and vaginal prostaglandin E2 gel for induction of labor at term. Pregnant women at term with a singleton in cephalic presentation, intact membranes, an unfavorable cervix with an indication for induction of labor and without a prior caesarean section were enrolled. The analysis was performed from a hospital perspective and all direct medical costs from randomization to 6 weeks post-randomization were included. Health outcomes were expressed as adverse outcomes (e.g. asphyxia and hemorrhage) and neonatal admissions. Sensitivity analysis was performed for multiple parameters. www.AJOG.org Diabetes, Labor, Medical-Surgical-Disease, Obstetric Quality & Safety, Prematurity, Ultrasound-Imaging Poster Session II